«ANSA Alternatives to Neo-liberalism in Southern Africa The search for Sustainable human development in Southern Africa Editors: Godfrey Kanyenze, ...»
Dealing with migration within the national policy calls for a greater focus on what makes health workers stay in the systems. Factors that include schooling for children, accommodation, standards of living, working conditions and professional paths strengthen incentives for workers to remain in health systems, even while wider issues are addressed.
It is evident however that many Southern African countries do not have even the critical mass of personnel to deliver on the most basic health services. A massive reinvestment in health personnel is needed in many countries, and the macroeconomic frameworks that imposes limits to this (METF and public sector employment frameworks) need to be revisited (and the assumptions informing them questioned) as without health personnel there is no health system.
Several options have been proposed in the past:
• Restitution, also commonly called reparation, requires hiring countries to pay monetary compensation to source countries.
• Ethical codes of practice aim to limit damaging types of recruitment and protect the rights of migrants.
• Human resource training and planning in recipient countries seek to improve the supply of human resources for health and lessen the need for international migration.
• Bonding tries to place financial sanction against emigration for individual health workers in source countries.
• The strengthening of health systems in countries of origin seeks to promote positive factors for the retention of health workers.
• Managed migration takes a positive approach to migration and seeks to formalise and grow the positive benefits, including encouraging the return of migrants.
• Auxiliary worker training suggests training the less wellqualified health workers in their countries of origin as they are less in demand in the health systems of high-income countries.
These methods are all under debate. There is evidence from an analysis of flows of health workers before and after ethical codes that indicate that alone they are not effective. If we are to redress and stem the subsidies from the largely public sector training systems and services of Southern Africa to the private and public sector health services of the north then investment is needed in the health systems, working and living conditions and training of health workers in Africa. The costs of migration to the public sector in Africa have been significant and inequitable, calling for global redress and support for the measures that encourage health worker retention within their systems.
Health is an area of profound contradiction in the current process of neoliberal globalisation. The reality is presented in disturbing images of the costs in health (Aids, mortality, famine and food security and collapsing health systems) strikes a moral repugnance in the public of the North as well. Health is thus an area where the ideological struggle is profound, sometimes vicious, even if it is masked in highly technical arguments.
This calls for a strong uniting perspective in Southern Africa that can act as a platform for coherent, public interest-oriented policy and action across the state, health workers and civil society; a programme of work that can build political and social action around this perspective and inform and hold to account engagement within global processes. This means deliberately rejecting approaches that reshape our health systems into programme packages, purchased and delivered like commodities, determined by cost effectiveness and shaped and decided by a small tier of technical and economic elites. A uniting perspective goes beyond resistance to neo-liberalism. At present much energy is focused on resisting or coping with measures that increasingly cast patients as customers or consumers; healthcare as a commodity rather than a service; and that pose that competition within the health system is a greater virtue than co-operation and collaboration.
This paper argues that shared values of public interest, universality, solidarity and equity must be core to this uniting perspective and the basis for shaping and defending the alternatives to neo-liberalism that are being framed within the region.
The paper poses in the previous section some key sites of struggle through which the concrete policies around these values can be shaped and the direction of alternatives based on these values. All of these areas can be further detailed with specific evidence and information. However a study is not a substitute for action. There has been a significant loss of trust between state, health workers and civil society generated by the perceived self-interest that grows when financial incentives dominate health service provision.
Action around these key areas thus needs to:
• Interpret current trends and policy options for the ideological choices they imply, and unmask the ideology within technical arguments and options • Train cadres within civil society, health workers and state to enlarge the critical mass of people needed to interpret and shape policies and responses • Resist measures that narrow the space and flexibilities for future action (such as the GATS agreements) • Build debate, dialogue and understanding within and across key constituencies around the priority areas of policy and action, strengthening existing initiatives that are already doing this • Deepen the development of shared policies, platforms to take them forward, joint actions around them and shared resources to support them across constituencies and across countries • Promote the implementation of and raise the profile of success stories and demand policies that would follow suit.
The potential for synergy between state, civil society and health workers that exists in health and the visible costs to the health of current neoliberal globalisation makes health one of the leading areas for a struggle against neo-liberalism, and more importantly for alternatives rooted in the core social values of the region.
Part of the task in achieving this is to build supportive and transformative relations between state and citizens. Orthodox neo-liberal economic policies undermined the legitimacy of post independence democracies and their state processes. While many governments in the region have attempted to take strong positions to defend the national policy in global platforms (there have also been periods in which the Southern African governments have responded to globalisation by developing their own authoritarian politics), they have lost legitimacy due to the implementation of neo-liberal policies and have undermined citizen–state relations through privatisation and commercialisation policies that have marginalised and impoverished citizens, leading to loss of confidence in the state. To assert alternatives to neo-liberalism that centre on a redistributive state, we need to build and strengthen alternative conceptions and forms of democracy in the "public sphere" at local, national and regional level that satisfy the demand for meaningful participation in communities in Southern Africa.
The pace of neo-liberal globalisation is at present outstripping the pace of the response. Southern African countries need to carve the space to build an alternative. Regional integration has been posed as one means towards achieving this. Countries, such as Malawi and Zambia, that are prejudiced by commitments made under their health sectors, need to be able to call on wider regional and African alliances to strengthen their bargaining positions to remove commitments that undermine public health. If effectively used, regional integration provides a vehicle for strengthened negotiating power and shared capacities, information and resources. The SADC Protocol on Health, developed in 1999 and ratified in 2004, provides such a vision of regional co-operation and collective action in health.
The opportunity for such regional co-operation cannot however be assumed to be the reality. It needs to be monitored, promoted and protected. There is a world of difference between a regional "integration" that facilitates the spread of private medical and service sector businesses to take over health and essential services for a small high-income market, and a regional integration that uses market size, resources, production systems, regional trade and exchange of knowledge to consolidate public health systems. The two paths are separated by the choices made on whether social policy must be organised around universality, redistribution and solidarity. The consequences of that choice are not only important for how the region shapes its social policies but the systems and services we build on these choices also shape our societies.
Chapter 12 Education
This paper examines educational developments in Southern African countries from colonial times in the nineteenth century to the present. It begins with a historical survey of the Southern African system under colonialism and in the immediate post-colonial period. It then looks briefly at the worldwide economic crisis of the early seventies and the growth of neo-liberalism in the world, including Southern Africa. This is followed by an examination of some of the main impacts of globalisation and neoliberalism on Southern African education systems. It concludes with a look at the possible approaches that could be utilised to mobilise our societies to examine, and to undertake, alternative strategies for development.
2. Education under colonialism
The colonial period saw the introduction of European type education systems into Africa. Indigenous forms of education – both formal and nonformal – continued to be important long after the establishment of colonial rule but their legitimacy and importance were not recognised. Indeed indigenous education was undervalued and looked at with contempt by colonial regimes.
European models of education were initially introduced by missionaries who wanted to teach the colonial languages and to use education as a tool to convert Africans to Christianity and as a means of spreading "European civilisation". Missionaries established a small number of well-known mission schools throughout the sub-continent, providing a relatively high level of academic education at primary and secondary levels and even training clergymen and teachers. Some former students of these schools took up junior positions in the civil service and a few found their way into professions such as law or journalism, sometimes after further study abroad. The majority of mission schools – mainly village primary schools – were very poorly resourced and only gave children the basics of literacy and numeracy as well as religious instruction. (Hartshorne 1992:24). In some colonies, colonial regimes subsidised mission schools and also established a small number of state schools for Africans.
Most schools gave African children some of the skills required by low-level labourers in the colonial economies without providing higher-level skills training. They also provided – as much through the "hidden curriculum" as the formal one – training in the disciplines and subservient attitudes required by colonial employers. Whether in the form of subsidies to mission schools or allocations to state schools, the resources allocated to schools for Africans were far inferior to those allocated to the schools for the children of the white settlers (Statement by the Executive of the South African Native Congress, reprinted in Karis and Carter 1972:19). However, despite all this, the education of most Africans was completely neglected in most Southern African states and the vast majority of African children did not attend any school at all.
In settler states where independence took longer to achieve (e.g.
Zimbabwe, Namibia and, especially, South Africa) in the last preindependence decades, governments took firm measures to put the education of all Africans under state control. The Bantu Education system in South Africa, for example, became a system of mass education in order to provide low-skilled workers with basic levels of education to improve their effectiveness as workers in an industrialising economy.
While earlier forms of European education, such as that provided by missionaries, were meant to further the aims of colonial regimes and strengthen colonial subjugation, they sometimes had effects which were unintended by their designers. Many of the leaders of the anti-colonial movements were in fact products of the more prestigious mission schools.
To achieve their aims of independence, these leaders mobilised support from the masses of poor peasants and workers who suffered from colonial rule and also yearned for the removal of foreign domination. In South Africa, the pattern of an alien education system producing resistance to the society that imposed it, repeated itself in the context of an industrial economy. In the Soweto Uprising of 1976, secondary schooling, which had been expanded to help meet the needs for a semi-skilled labour force, became the birthplace for a new phase of the struggle against apartheid.
Most of the (missionary educated) leaders of independent African states appreciated the education that they had received even if they saw its limitations. In an increasingly interdependent world, the advantages of literacy, numeracy and other knowledge provided by schools was obvious not only to the new leaders but also to most others in the former colonies.
This led to a growth in the demand for schooling and other modern forms of education, and the newly independent states almost without exception prioritised mass education systems in their plans for national development.
3. Post-colonial education systems